How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices
As criticism of pharmacy benefit managers heats up, fear of lawsuits is driving some big employers to drop the “Big Three” PBMs — or force them to change.
Drugs
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News Analysis
Rage Has Long Shadowed American Health Care. It’s Rarely Produced Big Change.
The outpouring of anger at health insurers following the killing of UnitedHealthcare CEO Brian Thompson continues a cycle of rage that dates back decades.
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Who Gets Obesity Drugs Covered by Insurance? In North Carolina, It Helps If You’re on Medicaid
GLP-1 agonist medications such as Ozempic accounted for 10% of the North Carolina state employee health plan’s prescription drug spending, so the state is no longer covering them for weight loss alone. Still, it did decide to cover them for Medicaid patients’ weight loss. A look inside the state’s coverage calculus.
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Florida Gov. DeSantis’ Canadian Drug Import Plan Goes Nowhere After FDA Approval
Florida sued the FDA over what it said was a “reckless delay” in approving its drug importation plan. Now, nearly a year after the FDA gave the state the green light, the program has yet to begin.
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Listen: A Tussle With a Rattlesnake Can Take a Bite Out of Your Wallet
Listen to Թϲ' Jackie Fortiér recount how a backyard snakebite led to a harrowing hospitalization — and big bills — for a San Diego family.
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No Evidence Trump’s Drug Program for Terminal Patients Saved ‘Thousands’ of Lives
Though the former president has repeatedly hyped the impact of his experimental drug program, there’s no basis for his claims in government data, and medical experts say he’s exaggerating.
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What’s at Stake: A Pivotal Election for Six Big Health Issues
Health care has ebbed and surged as an election issue throughout the presidential campaign. Here are the ways some of the most consequential changes in health policies could hinge on whether Vice President Kamala Harris or former President Donald Trump wins.
Less Than Two Weeks To Go
Episode 369With Election Day rapidly approaching, abortion is gaining traction as a voting issue, according to public opinion polls. Meanwhile, states with abortion bans are reviving the lawsuit — dismissed by the Supreme Court on a technicality this year — that could roll back the availability of the abortion pill mifepristone. Sarah Karlin-Smith of the Pink Sheet, Rachel Cohrs Zhang of Stat, and Victoria Knight of Axios join Թϲ’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Tricia Neuman, senior vice president of KFF and executive director of its Program on Medicare Policy, about Medicare open enrollment and the changes to the federal program for 2025.
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PBM Math: Big Chains Are Paid $23.55 To Fill a Blood Pressure Rx. Small Drugstores? $1.51.
Criticism of prescription drug middlemen has intensified recently in the wake of a federal agency’s actions and legislative reform attempts. Georgia Republican Gov. Brian Kemp, though, vetoed a related bill that would have helped independent pharmacies, citing the unfunded cost of the move.
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Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More.
Every year, Medicare officials encourage beneficiaries to shop around for their drug coverage. Few take the time. This year, it might be more important than ever.
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Journalists Address Opioid Settlements, Undiagnosed ADHD, and a Georgia Chemical Fire
Թϲ and California Healthline staff made the rounds on national and local media in the last two weeks to discuss topical stories. Here’s a collection of their appearances.
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Helene and CVS Land Double Whammy for 25,000 Patients Who Survive on IV Nutrition
A Massachusetts woman ended up stranded in the hospital because CVS stopped providing the IV nutrition she needs to survive at home. Without it, she’d starve.
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California Continues Progressive Policies, With Restraint, in Divisive Election Year
This legislative cycle, Gov. Gavin Newsom signed bills affirming reproductive rights and mandating insurance coverage of in vitro fertilization, but the Democrat was reluctant to impose new regulations and frequently cited costs for vetoing bills.
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Colorado’s Naloxone Fund Is Drying Up, Even as Opioid Settlement Money Rolls In
Since Colorado created a pool of money to pay for naloxone in 2019, it has distributed more than half a million doses of the opioid reversal drug to hundreds of organizations throughout the state. Now, its main funding stream is drying up.
Yet Another Promise for Long-Term Care Coverage
Episode 367As part of her presidential campaign, Vice President Kamala Harris has rolled out a plan for Medicare to provide in-home long-term care services. The proposal would fill a longtime need for families trying to simultaneously care for young children and older parents, but its enormous price tag makes it a promise unlikely to be fulfilled. Meanwhile, a growing number of Republican candidates up and down the ballot facing voter backlash over their support for abortion restrictions are trying to reinvent their positions. Shefali Luthra of The 19th, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of Johns Hopkins University and Politico join Թϲ’ Julie Rovner to discuss these stories and more. Also this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris campaign about health care issues.
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Employers Haven’t a Clue How Their Drug Benefits Are Managed
The Big Three pharmacy benefit managers say they return nearly all the rebates they get from drugmakers to the employers and insurers who hire them. But most employers seem to doubt that.
By Arthur Allen -
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What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period
This year’s start date in most states is Nov. 1, and consumers may encounter new scams as well as important rule changes.
The Health of the Campaign
Episode 366The 2024 presidential race is taking on a familiar tone — with Democrats accusing Republicans of wanting to ban abortion and repeal the Affordable Care Act and Republicans insisting they have no such plans. Voters will determine whom they believe. Meanwhile, for the second time in a month, a state judge overturned an abortion ban, but few expect the decision to settle the matter. Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Anna Edney of Bloomberg News join Թϲ chief Washington correspondent Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Թϲ’ Lauren Sausser, who reported and wrote the latest Թϲ-Washington Post “Bill of the Month,” about a teenage athlete whose needed surgery lacked a billing code.